Brown Samuel M, Wilson Emily L, Presson Angela P, Dinglas Victor D, Greene Tom, Hopkins Ramona O, Needham Dale M
Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah, USA.
Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah, USA.
Thorax. 2017 Dec;72(12):1094-1103. doi: 10.1136/thoraxjnl-2017-210337. Epub 2017 Aug 4.
With improving short-term mortality in acute respiratory distress syndrome (ARDS), understanding survivors' posthospitalisation outcomes is increasingly important. However, little is known regarding associations among physical, cognitive and mental health outcomes. Identification of outcome subtypes may advance understanding of post-ARDS morbidities.
We analysed baseline variables and 6-month health status for participants in the ARDS Network Long-Term Outcomes Study. After division into derivation and validation datasets, we used weighted network analysis to identify subtypes from predictors and outcomes in the derivation dataset. We then used recursive partitioning to develop a subtype classification rule and assessed adequacy of the classification rule using a kappa statistic with the validation dataset.
Among 645 ARDS survivors, 430 were in the derivation and 215 in the validation datasets. Physical and mental health status, but not cognitive status, were closely associated. Four distinct subtypes were apparent (percentages in the derivation cohort): (1) mildly impaired physical and mental health (22% of patients), (2) moderately impaired physical and mental health (39%), (3) severely impaired physical health with moderately impaired mental health (15%) and (4) severely impaired physical and mental health (24%). The classification rule had high agreement (kappa=0.89 in validation dataset). Female Latino smokers had the poorest status, while male, non-Latino non-smokers had the best status.
We identified four post-ARDS outcome subtypes that were predicted by sex, ethnicity, pre-ARDS smoking status and other baseline factors. These subtypes may help develop tailored rehabilitation strategies, including investigation of combined physical and mental health interventions, and distinct interventions to improve cognitive outcomes.
随着急性呼吸窘迫综合征（ARDS）患者短期死亡率的降低，了解幸存者出院后的转归变得越来越重要。然而，对于身体、认知和心理健康转归之间的关联却知之甚少。确定转归亚型可能会促进对ARDS后发病情况的理解。
我们分析了ARDS网络长期转归研究中参与者的基线变量和6个月时的健康状况。在将数据分为推导数据集和验证数据集后，我们使用加权网络分析从推导数据集中的预测因素和转归中识别亚型。然后，我们使用递归划分法制定一个亚型分类规则，并使用验证数据集的kappa统计量评估该分类规则的充分性。
在645名ARDS幸存者中，430名在推导数据集中，215名在验证数据集中。身体和心理健康状况密切相关，而认知状况并非如此。出现了四种不同的亚型（推导队列中的百分比）：（1）身体和心理健康轻度受损（22%的患者），（2）身体和心理健康中度受损（39%），（3）身体健康严重受损且心理健康中度受损（15%），（4）身体和心理健康严重受损（24%）。该分类规则具有高度一致性（验证数据集中kappa=0.89）。拉丁裔女性吸烟者的状况最差，而男性、非拉丁裔非吸烟者的状况最佳。
我们确定了四种ARDS后的转归亚型，这些亚型可由性别、种族、ARDS前吸烟状况和其他基线因素预测。这些亚型可能有助于制定针对性的康复策略，包括对身心健康联合干预的研究，以及改善认知转归的不同干预措施。
